Acute compartment syndrome

Definition: compartment pressure rises to a level that decreases perfusion. Nerve and Muscle damage can be irreversible

High degree of alert ( Risk of amputation)

Compartment syndrome may occur anywhere that skeletal muscle is surrounded by fascia, but most commonly

• leg 

• forearm

• hand

• foot

• thigh

• buttock

• shoulder

• paraspinous muscles

Etiology

• trauma

  • fractures (69% of cases)

  • crush injuries

  • contusions

  • gunshot wounds

• tight casts, dressings, or external wrappings

• extravasation of IV infusion

• burns

• postischemic swelling

• bleeding disorders

• arterial injury

Symptoms

• pain out of proportion to clinical situation is usually first symptom

• Extreme pain on passive movement

• paresthesia and hypoesthesia

• Paralysis ( late finding)

• non palpable pulse : very late finding…

Diagnosis

• Compartment pressure should be measured at: rest, immediate post exercise and continuous post

  exercises for 30 minutes

• Diagnostic criteria 

  • resting (pre-exercise) pressure > 15 mmHg

  • immediate  (1 minute) post-exercise is >30 mmHg and/or

  • post-exercise pressure >20mmHg at 5 minutes

  • post-exercise pressure >15 mmHg at 15 minutes 

Exertional (chronic) compartment syndrome

• Reversible ischemia to muscles within a muscular compartment, during a specific sports activity

  • anterior leg compartment most commonly affected (~70%)

  • anterior and lateral leg compartment affected in 10%

• Symptoms (pain , paresthesia) are reproduced by exercise and relieved by rest: symptoms begin ~ 10 minutes into exercise and slowly resolve ~30-40 minutes after exercise

• Imaging are useless for diagnosis

Treatment

• activity modification

• 2 incisions fasciotomy (after 3 months of activity modification)

• 20% of recurrence rate after 2 years